Thoughts on the Pet Connection data

Pet Connection has an update. Their database of self-reported cases now stands at over 1500 sick or dead pets, half of whom are deceased. What does this mean? How useful are these numbers?

The data are self-reported, so we can’t be as confident about their significance as we could if they were collected by a randomized survey or in some other more rigorous manner. Potential problems with self-reported data include

omissions (One primary problem with surveys in which participants are self-selected is a bias in the survey results toward those who have strong feelings about the issue being surveyed. People who believe their pets have died because of the recalled food will be far more motivated to participate in the Pet Connection survey than those whose pets merely got sick. And would participation even occur to people whose pets ate recalled food but didn’t get sick? These factors need to be considered when evaluating the Pet Connection data.)

exaggeration (People with multiple pets eating multiple foods might have reasoned that because all their pets had access to affected food that all of them necessarily ate affected food. Such people would have reported in good faith, but their reports are potentially exaggerated.)

mistakes and faulty assumptions (On Tuesday I had an e-mail from a client wondering if her cat’s death late last year might have been caused by now-recalled food. She thought that her cat had died of kidney failure. I checked the cat’s history and found that we had, in fact, treated it for liver disease and that the cat had died in late November, before the recalled food was even manufactured. Had this client gone straight to Pet Connection instead of contacting us, she would have entered erroneous data based on what she thought had happened and her faulty memory of exactly when it happened. I’m not suggesting that most or even many pet owners did this, but the possibility is good that some did, and we should keep that possibility in mind. A more likely confusion will be between chronic and acute renal failure. CRF is quite common, especially among older cats. Some percentage of pet owners will hear ARF when their veterinarian has found CRF. Some veterinarians might mistake CRF for ARF in new patients that already have CRF but that are having an acute episode or have decompensated. Some pet owners will have pets with undiagnosed CRF that decompensate and die at home, and the owner will conclude that the death was from ARF caused by eating recalled foods.)

fabrication (I don’t think this is likely a large problem, but it should be considered.)

That said, the data are striking even if the collection method is not perfect. But even if we accept (for argument’s sake) that the data collected are flawless, we need to ask a different set questions as we attempt to assess their significance:

What are the baseline rates of ARF in cats and dogs? In other words, in a given week how many animals typically become ill with acute renal failure? My wife indicates that ARF is considered uncommon in cats. Still, veterinarians have only limited data to support that conclusion. Morbidity and mortality data are not routinely collected in veterinary medicine. Often the best guesses about how frequently a disease or illness occurs are nothing more than guesses. So, unfortunately, we really don’t have a good baseline with which to compare the Pet Connection data. Based on what we think we know (ARF is uncommon), the data are stiking. But with no real point of comparison, we can’t be sure that the apparent significance of the data isn’t really an illusion caused because we tend to look at new data from within our existing frame of reference. Here’s an example: My wife might see two or three acute renal failures per year, or one every four to six months. By comparison, the numbers reported by Pet Connection seem shocking. But let’s do some math. If my wife’s rate of two to three per year is extended across all the veterinarians in North America, you have 80,000 to 120,000 cases (I’m assuming a conservative 40,000 vets; the U.S. Department of Labor says there were 61,000 in 2004, but that figure includes industry, government, and other vets who don’t practice on small animals), or approximately 225 to 325 cases each day! In the five days since the recall was announced, we’d therefore expect to see 1,100 to 1,600 cases. In the real world, cases aren’t spread out that evenly, though, which leads to the next question.

When during the year do we normally see spikes in ARF? Are the data in line with or in excess of those spikes? In cats, we often see a spike in acute renal failure in late winter and early spring. This is probably related to the fact that Easter lilies start showing up in people’s houses around this time. All parts of the lily are toxic to cats and cause ARF. In both cats and dogs, rates of ethylene glycol–related kidney failure increase in the winter as people use more antifreeze in their vehicles. I have no information on how large the winter/early spring spike in acute renal failure is, but for argument’s sake let’s say it’s 10 percent. Returning to my earlier example, that would mean an additional 110 to 160 cases over the five-day period since the recall began. That brings us to 1,110 to 1,760 cases.

What percentage of acute renal failure patients die? The prognosis is generally regarded as poor. This communication from Tufts claims a survival rate of 41 percent for dogs with ARF that received dialysis, the gold standard for treatment. In human beings estimates of the mortality rate for ARF range widely, from 25 to 90 percent. The estimate for hospitalized patients is 40 to 50 percent. Applying the optimistic 40 percent mortality rate to my previous example, we would expect to see between 440 and 700 deaths over the five day period since the recall began.

As you can see, these numbers are in line with what Pet Connection is reporting. Does this mean their findings aren’t significant? Not necessarily.

If anything, the Pet Connection numbers are an underreport. Many pet owners and veterinarians will have been unaware of Pet Connection. Gina has several times requested that site visitors who have told their pets’ stories on the blog also add the info to the registry. Undoubtably some of those people never did so. I think we can feel confident that the Pet Connection numbers are only a piece of the pie. How small a piece is the question.

Second, the assumptions I’ve used in trying to compare the Pet Connection data with what might be expected to occur normally could be way off. Is my wife’s experience of two to three ARF cases per year typical, higher than average, or lower than average? Estimates of poor prognosis in renal failure are mainly based on the fact that presenting cases are often already quite ill. Awareness of the recall and prophylactic measures by veterinarians and pet owners may have caught many potentially serious ARF cases early enough that the exisiting mortality estimates don’t apply.

The point of all this is not to criticize the good folks at Pet Connection. The work they have done to compile the data and to promote awareness of the recall is greatly appreciated and will doubtless save pets’ lives by making people more aware that a serious problem exists. Their data will prove of great value down the road, too, as researchers try to answer what happened, how widespread the problem was, and other questions. Finally, the data do indicate that a serious problem is occuring and that pets are dying. But members of the veterinary commuity have an obligation to think critically, to step back and try to assess the situation. I am far from the best person to do that, but I hope these initial efforts on my part will encourage others who are more qualified to share their thoughts.

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38 Responses to “Thoughts on the Pet Connection data”

I realized one major error in my thinking: My wife treats only cats, so all of the numbers I came up with apply only to cats. Cats do seem to be more affected by whatever is going on. The Pet Connection numbers show about 4.5 deceased cats for every three dogs. Unfortunately I don’t know anything about the ARF rate in dogs, so any speculation would be wilder than what I’ve already done. All other things being equal, however, I believe it is fair to say that I underestimate the number of total (cat and dog) cases of ARF that would typically be seen.

Is there a possibility that more than just renal failure is going on? Our own dog who ate canned Iams presented with symptoms like poisoning – severe diarrhea and vomiting, lethargy and weakness. Is liver failure from some sort of toxin or bacteria part of this problem as well?
At this point the company isn’t really admitting much, claiming they haven’t found a real problem though they are pointing at this new “filler” wheat gluten and admit to killing some of their own research animals. Maybe dogs are falling ill in different ways than cats.
Barb P.

I’m sorry to hear there is no CDC for animals to make this investigation more accurate.
Rather than use annual statistics, I think monthly numbers for the particular months the food was sold would be a better comparison, wouldn’t it? for ARF?
Was every state of the U.S. selling the recalled food? If not, only the kidney-failure deaths in those states could be counted and compared for a better statistical evaluation.
My cat also ingested dry food and possibly extended his life/death.

I dont think this article helps. My cats have never been sick in ten years, yet now they are deathly ill, it seems like poisoning. (also three weeks ago they had blood tests that were normal, before all this) That should be a factor in how data is dealt with. Broad stats of how many cases per year really doesnt apply to the person like me.

Thank you so much for posting these thoughts, and for all the postings over the past week. This is one of the few sane places I’ve seen in all this mess — intelligent thought rather than rumor-induced panic. I am seeing these numbers reported as though it’s fact, not only the numerical value, but as if there’s proof they’re all due to the food issue. We have to look at this seriously, but at the same time keep our emotions and reactions in check. So I really do appreciate finding some sane, intelligent articles here.

[…] we have stressed that they are self-reported, and what that means. (We also posted a link to this thoughtful analysis on vetcetera.) We have stressed that we consider our numbers indicative of a trend that will bear […]

Two days before the pet food recall, our son’s older cat had to be put to sleep for acute liver failure, though she had had kidney problems a year ago. I don’t have the kidney test values, but our vet definitely told us it was liver failure and she was obviously jaundiced. She had lost about 4 pounds down to only 6 pounds in only a few days. At that point we had no idea what could have caused her to become ill. By Saturday we heard that the Schnuck’s Turkey & Gravy canned food was being recalled, which she and his other cat had eaten, along with several other Schnuck’s canned varieties. The younger cat was checked this past Monday, her tests were fine, and she is still doing fine. I am wondering whether the tainted food made her feel sick enough to stop eating without damaging her kidneys enough to show kidney failure, but the fact that she stopped eating for several days was what caused her liver to fail. Of course, our son does not have the emptied cans of turkey which supposedly were contaminated, and the one remaining beef and gravy can was returned in the recall, so we have none of the proof that Menu Foods is requiring even to take information on a pet’s death,
but all we are interested in is that the cause is discovered and the prevention of such damage to our nation’s pets in the future.
Thank you for providing your thoughtful analysis and a source of good information.

I was one of those who reported the death of my dog Brandy on petconnection.com I do very much appreciate your dispassionate and scientific approach. While I agree with everything you have said here, one of the flaws that I have seen is in fact a remarkable lack of application of science by our local vet community.

Brandy’s case is certainly not clear cut. She had a pre-existing condition of bladder tumor(s) and was 14 years old. Also, although the food she ate was one of the recalled products it had an older expiration date of 10 09.

Despite this, she had been doing well all winter and was on an anti-inflamatory that helped her markedly with passing urine. The onset of her accute illness was notably coincidental with a change of her food from Alpo to Sprout Beef Cuts & Gravy. Her symptoms included weakness and lethargy, shivering, profuse night time bed wetting, she stopped eating, a bright scarlet red tongue and the left side of her face was swollen in the soft tissue.

The vet wrote all of these symptoms off as “red herrings” and palpated her abdomen stating that her bladder was distended from the tumors. Even when I pointed out that the volume of fluid she passed at night in her bed when she relaxed was far beyond normal she persisted in that diagnosis.

When we put Brandy to sleep she immediately leaked uring all over the vets floor causing her to call an assistant to remover her on a stretcher to my truck where perhaps another quart or more flooded the bed. She was the size of a small border collie and probably a mix of that an sheppard. By the next morning bloody saliva had pooled in her mouth and leaked onto the tarp I had her wrapped in.

This was on March 15th. On the morning of the 17th while watching the Today Show I learned of the recall and spoke to an associate at the clinic who told me to keep her body cool until Monday for possible examination and that someone would contact me.

By Tuesday I called again and was treated very rudely by the doctor who when I asked for a post mortem shouted me down citing probably organ deterioration and the fact that our lot number was not on the recall.

Excuse me, but the purpose of the PM and making the report to the FDA would have been to determine if more lots needed to be added to the recall. I have since left a message with the FDA office in MN for that purpose although Brandy has been burried for a week now. But, I do still have the remaining cans which could be tested.

If it turns out that the food she I fed her were NOT tainted it would in fact be much easier to put this all behind me and then perhaps maybe it was simply her time. But the all too coincidental feeding of a product that has to be considered suspect is a bit too much to leave untested. That is why I entered Brandy in the database. At the same time I fully accept the idea that many animals being reported there including Brandy died of completely may very well have died of completely unrelated illnesses.

As a single counterpoint to your comments I would suggest that if the behavior of my vet is in any typical of vets in the field then I think that there is at least good evidence that more official sources are under reporting incidents.

What the public is looking for here is the peace of mind that their pets (and even themselves) are being treated with professional standards that will tell them the truth when all of the evidence is examined and not dismissed by finanical interests or sloppy science.

A slight correction: The vet said that her bladder was distended by retained urine and not the tumors themselves. My point about the bed wetting and leaking after death was that her urinary tract was not that blocked and she was in fact producing large amounts of excess urine that may have been causing a prolapse exagerating the blockage we knew she already had. This theory was in fact supported by the other vet.

[…] Throughout the unfolding pet-food crisis, the vetcetera blog has provided the necessary counterpoint to what we’ve been reporting here on Pet Connection. In thoughtful, well-reasoned posts, that blog (written by a veterinary practice manager whose wife is a board-certified feline specialist) has looked at what we were doing and questioned the good and the not-so-good of it. His contributions have been valuable, especially his evaluation of what our PetConnection database of self-reported numbers really means. […]

At least 471 cases of pet kidney failure have been reported in the 10 days since a nationwide recall of dog and cat food and about a fifth of those pets have died, a veterinarians’ information service said Tuesday.

The maker of the recalled pet food has confirmed the deaths of only 16 pets.

Paul Pion, founder of the Veterinary Information Network, which counts 30,000 veterinarians and veterinary students as members, said Tuesday the number of reported kidney failure cases had already grown higher than the 471, but he said he wouldn’t have an updated tally for a few days.

Of the reported cases, he said, 104 animals have died. The network’s survey results were earlier reported by the Los Angeles Times.

Pion, a California veterinarian, said only 10 percent to 20 percent of the people who belong to his Web site had responded to a request for information.

“If we’re only getting 10 percent of the veterinarians, you can do the math,” he said.

Veterinarians Information Network, a website of 30,000 veterinarians and veterinary students, said members had reported 471 cases of kidney failure in the 10 days since Canada-based Menu Foods Income Fund announced its pet food recall.

In Los Angeles County, health officials reported 10 confirmed pet deaths — five cats and five dogs — from kidney failure in recent days and 15 additional cases of very sick animals with similar symptoms. The department said it was checking 86 other cases related to the recalled food.

As investigators look for a cause behind the 15 confirmed pet food deaths, doctors at New York’s Animal Medical Center suspect there will be a much larger rash of cases after learning of an additional 200 cases of kidney failure in animals.

Doctors at the hospital, which is considered the Mayo Clinic of veterinary medicine, say they noticed the kidney failure while studying sick animals from last Friday to Monday, and traced the cases back to the 60 million cans and pouches of recalled food from Menu Food.

“I was shocked and surprised, acute kidney failure is not a common problem,” veterinarian Cathy Langston told ABC’s David Kerley. “I’ve already heard about 200 cases, and so I bet that there are probably going to be thousands.”

For a future blog post, a clarification on acute vs chronic renal failure would be very helpful. Our seven year old male cat had a full workup in the fall and was in good health overall. He fell sick two weeks before the recall: vomiting, lethargy, anorexia. We took him in and his urine was significantly dilute. A subsequent ultrasound led to a diagnosis of chronic renal failure — yet our vet was very puzzled that this should emerge so young in an otherwise perfectly healthy cat. The next day the recall came out: our cat had been eating Nutro Natural Choice in the affected lots for the entire period of the recall. Ironically, we’d changed over in the fall on our vet’s recommendation because the vet felt our cat needed to up his fluid intake. Our vet called US at 8am Monday morning to say he was reporting our case to the FDA and we should too. So, my questions are, are CRF and ARF sharply distinct in cats? Does the tainted food cause ARF only? Should our cat’s diagnosis have been changed? Or does the poisoning produce slow degradation that mimics CRF in older cats, as well as the sharp deterioration found in ARF in a cat of any age?

[…] our numbers, and we have always pointed out the limitations, and also pointed frequently to others doing the same. We have also from the first insisted that people who reported pets into our database also report […]

Quote:
Renal failure may be either chronic or acute. Chronic Renal Failure (CRF) is a progressive, irreversible deterioration of kidney function. Because cats hide their illnesses and the very early signs of CRF are subtle, this disease may only be recognized when the patient reaches the 70% deterioration level and more dramatic symptoms are observable. The seemingly sudden onset may appear to be an acute condition but is most often a crisis point of CRF. By comparison, Acute Renal Failure (ARF) is characterized by an abrupt shutdown of kidney function, most often accompanied by oliguria (reduced urine production). The primary causes of ARF in cats are: urinary obstructions, infectious diseases, trauma, and the ingestion of toxins – the most common one being ethylene glycol which is contained in antifreeze. ARF is extremely serious and can quickly become fatal. Immediate veterinary treatment is imperative. Though the prognosis is usually poor, if damage has not been too severe and medical treatment is aggressive, it may be possible for normal kidney function to be restored.

Quote:
ARF is contrasted with chronic renal failure (CRF) in which there is a gradual death of nephrons with the remaining nephrons functioning in a normal or supra normal capacity. ARF is potentially reversible whereas CRF is a progressive and irreversible condition.

Diagnosis

The patient history, physical examination and laboratory data may all support a diagnosis of ARF.

The history may provide a clue as to the cause of ARF. For example the animal may have had recent anesthesia/surgery causing hypotension, may have been receiving a drug which has the possibility of being nephrotoxic or may be a free-roaming animal which has the potential for exposure to toxins such as antifreeze. Patients with chronic renal failure may have a history of polyuria and polydipsia and may abruptly decompensate, presenting in a crisis like an ARF patient. CRF patients can sustain acute insults (ARF super imposed upon CRF).

Physical examination often reveals a depressed, hypotensive, hypovolemic and sometimes hypothermic patient. Hypovolemia is due to fluid loss in vomitus and diarrhea and lack of intake and in some patients, hypovolemia is the cause of ARF.

Given the acute nature of their disease, the patient is often in good body condition compared to the chronic renal failure patient which may be in poor body condition.

Fever may be present if ARF is from an infectious cause such as acute pyelonephritis or leptospirosis. Tachypnea may be observed and is present to eliminate CO2 to compensate for metabolic acidosis.

Bradycardia may exist due to hyperkalemia but hyperkalemic patients may have a normal heart rate. As the patients are usually hypovolemic and the cardiac response to hypovolemia is to increase the heart rate, the two opposing influences on heart rate may result in a normal heart rate.

The kidneys may palpate normal to large. Enlarged kidneys may be painful when palpated as pain receptors in the capsule of the kidney are stretched as the kidney enlarges.

The most common change in mentation is depression but seizures may occur in terminal uremia or due to toxins such as ethylene glycol.

Get this, Purina issued their recall on Friday (March 30th)- I emailed my mother on Sat. with the announcement, she didn’t get to read her emails, went shopping at our local Sams Club (ct) on saturday afternoon (after 3PM) purchased ALPO prime cuts from a huge display. Sunday night she opened a can & luckily her finniky dog wouldn’t eat it. Monday AM she read my email & called Sams. They had just removed the display. Bottom line: DO NOT BELIEVE THAT THE FOOD IS SAFE JUST BECAUSE IT IS ON THE RETAILERS FLOOR DISPLAY!! Irresponsible store personnel are slow in removing the potentially dangerous products. We, as consumers, must take the initiative to protect our own pets (not to mention ourselves) because no one else cares about them as much as we do. What would I care about monetary compensation if my beloved babies were poisoned? It wouldn’t bring them back to me.
Further I believe the pet food industry is only the tip of this iceburg-Wheat Gluten is used in many products we all consume on a daily basis. It is back to single food sources for me! IE: apples, carrots, potatoes….you get the idea…

Other then that our cats seem to be fine. I don’t think they were eating the food that was recalled and the stuff they did have was old. My mom buys food to last all year, which I suppose in this case worked out better.

My 6yr.old pet dog died March 11,07 before the recalls came out. And I know its all about the wet food. But what about the dry food. I have spoken with local people whose pets also died after eating the dry food. Their pets were healthy and not old. All this happened around the same time frame as mine. I have also read other blogs of people whose pets have died from eating dry food. Are they making it up? I’m not. Fact is my pet died and I really dont know why. My vet didn’t sound convincing because I don’t think she really knew why either.

Proof might be obtained if pet food was purchased on credit cards. Major stores like Walmart’s computer system are able to identify each item purchased by credit card. This would provide the needed data (dates and food purchased) to analyze the actual pet death data. I wish our gov’t would step up to the plate and be more vigilant about protecting pet owners as consumers.

My cat got lucky as he was on a diet that integrated human quality proteins, supplements, canned pet wet food and dry kibble. His food risk was diversified, so he survived. But I missed integrating the early signs of “never before” behaviors into a full red alert: *Repeated( vomiting, tinkle *on the carpet*, hibernating, lethargy, running from the food bowl, drinking *an entire bowl* of water … I can’t shake the feeling that the dry food was involved too. He used to like Science Diet kibble and won’t go near it any more, he got most sick over their recalled wet food.

This all happened before the recall, so technically it’s a moot point for me. Liek so many others, I had to deal with it in the dark. My vet bills had better be repaid, his condition is still watchful, his urine samples still need future testing.

As far as all these numbers being anecdotal, and some likely not quite attributable to the tainted food, in the end, we all go with our gut feel about a written story. I’d give + or – 5 percent what you get with most fast surveys.

What’s important to me: No statistic or court decision is going to convince me that the Science Diet dry food in my house wasn’t ALSO involved… he went “off” the dry first … and no settlement can cure my kitty being afraid of his food bowl even his new one, or the way that makes me feel, in the end that is not the answer.

What this has done was give the Global Industrial Food Order a heads up that our entire food chain (and the water chain if you follow the China wheat gluten story) – human and pet – is in great jeopardy.

Our pets took the first big hit for us. But we can honor their memory and suffering by doing something real about it: Eat locally.

besides the pet food recall there are hundreds if not more pets dying of poisen, cat and dog pesticides, which i believe in my pets case manifested itself as acute renal failure. look up farnam on net, although there are other brands in question.

My dog got sick when he some kind of food that came from our neighbor. I got mad and starting that time, i only gave my dog the best and most trusted food and stuff. I got them from pet supply and accessory.

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